NPI | 1306377320 |
---|---|
Entity Type | Organization |
Authorized Contact | RAMKRISHNA SURENDRAN Md 248-759-5460 |
Organization Subpart ? | No |
Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MI RS075798) |
Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: MI SR079574) |
Enumeration Date | 2017-03-22 |
Last Update Date | 2017-03-22 |